Independent Contractor Analysis - Florida Department Of Revenue Page 2
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3RTS-6061
R. 07/16
Page 2
Information on this form is provided by:
Employing Unit/Business
Worker
Section II
1.
Did the worker perform services at the employing unit’s place of business? ......................................
Yes
No
2.
Could the worker perform services for a competitor of the employing unit? .......................................
Yes
No
3.
Did the worker use any of the employing unit’s equipment or tools? ..................................................
Yes
No
4.
Were the worker’s business or travel expenses reimbursed by the employing unit? ...........................
Yes
No
A) Did employing unit provide a vehicle? ......................................................................................
Yes
No
B) Did employing unit pay for gas and maintenance? ..................................................................
Yes
No
5.
Did the worker receive any training from the employing unit? .............................................................
Yes
No
A) If yes, was it mandatory? ..........................................................................................................
Yes
No
B) Was training paid for by employing unit (if applicable)? ...........................................................
Yes
No
6.
Could the worker sub-contract the job or hire and pay others to do the work? ..................................
Yes
No
7.
Did the worker hire and/or supervise other workers who were paid by the employing unit? ..............
Yes
No
8.
Was there a written contract between the employing unit and the worker? ........................................
Yes
No
If yes, provide a signed copy.
9.
Were there set hours of work? If yes, set by whom? ___________________________________ ...........
Yes
No
10. Did the employing unit give the worker instructions about:
A) When to do the work? ...............................................................................................................
Yes
No
B) How to do the work? ................................................................................................................
Yes
No
C) Sequence in which the work was done? ..................................................................................
Yes
No
D) Could the worker refuse assignments without penalty? ..........................................................
Yes
No
11. Did employing unit provide a uniform, identification badge, business cards? (Circle all that apply) ..
Yes
No
12. Could the worker provide services for the employing unit outside of the unit’s regular business hours? .
Yes
No
13. Was the worker required to keep the employing unit informed of the progress of the work?..............
Yes
No
14. Did the worker bill the employing unit for services performed? If yes, provide a copy. ......................
Yes
No
15. Was the worker paid by time (hourly, weekly, or monthly), salary, commission, or by the job? (Circle all that apply)
16. Did the employing unit provide health or life insurance, vacation pay, holiday pay, sick pay, retirement benefits,
workers’ compensation coverage, bonuses? (Circle all that apply)
17. Was the worker supervised by an employee of the employing unit? ...................................................
Yes
No
18. Was the worker in business for himself/herself? ..................................................................................
Yes
No
A) If yes, what is the business name? ______________________________________________________________
B) If yes, what is the worker’s federal employer identification number? _________________________________
C) If yes, did the worker have a financial investment in the business? .........................................
Yes
No
D) If yes, did the worker advertise to the general public? .............................................................
Yes
No
E) If yes, did the worker carry business liability insurance? ..........................................................
Yes
No
F) Does the worker have a business tax receipt in this field? If yes, provide copy .......................
Yes
No
19. Could the worker quit or be discharged at any time without a breach of contract penalty? ...............
Yes
No
20. Was the worker responsible for redoing defective work without additional compensation? ...............
Yes
No
21. Do you believe the worker was an
employee or
independent contractor? Explain. (Attach additional page
if needed): NOTE: The Department’s website contains a list and description of the 10 factors used to determine
worker classification. _________________________________________________________________________________
_____________________________________________________________________________________________________
22. What control, or right of control, did the employing unit have over how the work was to be performed? State any
examples of when this occurred. (Attach additional page if needed): _________________________________________
_____________________________________________________________________________________________________
_____________________________________________________________________________________________________
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